| NPI | 1871370718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-24-321295) |
| Additional Taxonomies | 104100000X Social Worker (Licence: FL CBHCM.0105863) |
| Enumeration Date | 2023-09-13 |
| Last Update Date | 2024-01-22 |